New therapeutic options for the management of diabetes

To review new hypoglycemic and antihyperglycemic agents recently approved for the treatment of type 1 and type 2 diabetes mellitus.

A MEDLINE search of articles published from 1966 to March 2006 was conducted to identify English-language literature available on the newer therapies approved for the treatment of diabetes. Search terms used were: Byetta, exenatide, insulin detemir, NN304, Exubera inhaled insulin, Levemir, pramlintide, Symlin, AC137, AC0137, and Tripro-Amylin. These articles, abstracts, and data provided by the pharmaceutical manufacturers were reviewed to identify pertinent data. Additional references were obtained from the bibliographies of these publications.

Randomized, English-language studies investigating safety or efficacy data on these newer agents with a focus on human studies.

These hypoglycemic and antihyperglycemic agents were reviewed with regard to background information, pharmacokinetic and pharmacodynamic data, relevant clinical studies, U.S. Food and Drug Administration-approved indications, dosing and administration, contraindications, drug interactions, adverse effects, storage, cost, availability, and role in therapy.

Over the last decade, management options for the treatment of diabetes have exploded. Among these are the incretin mimetics, amylin analogs, insulin analogs, and inhaled insulin. Short-term studies demonstrate that each of these therapies may offer specific advantages such as improved glycemia, convenience, and/or weight loss. Continued study of the incretin mimetics, amylin analogs, and inhaled insulin will be needed to verify long-term safety and efficacy of these agents.

These agents with novel mechanisms of action and a new insulin-delivery device offer patients and clinicians additional options that improve glycemic and nonglycemic factors while addressing some of the concerns of older agents. Longer term studies will help providers weigh the benefits, adverse effects, cost, and unknown long-term risks of these medications.